Monday, March 06, 2006

IN MY VIEW: Is There Any Longer a Need for Scientific Research in Tobacco Control?

You can call it a crisis if you want to. I'm about midway through my professional career and I am beginning to doubt whether there's any value in continuing along the lines of research I've been pursuing for the past two decades.

Much of my research has focused on the health effects of secondhand smoke exposure, evaluation of the level of exposure to secondhand smoke in different occupational settings, and evaluation of the impact of smoke-free policies. I think that my work, especially my publications on the specific impact of secondhand smoke on bar and restaurant workers, has played a significant role in policy development. I know that my work is cited often in policy debates and I would like to think, at least, that my research focus on the health effects among workers has helped re-frame this issue from one of customer comfort to worker health. And that frame shift has, I think, been one reason why advocacy for smoke-free policies has been more successful than when the focus was on protecting restaurant patrons.

But I'm at a crossroads. It is no longer clear to me that the science really matters anymore. Things have changed in the tobacco control movement, and there seems to be little concern about the science and scientific accuracy and integrity. Instead, the focus seems to be on the agenda.

It used to be that the science, including research that I conducted and reported, helped to shape and support the agenda. Now it seems that the agenda is shaping the interpretation of, and response to the science.

Is it really necessary for me, for example, to continue to do careful scientific research on the health effects of secondhand smoke when a group like ASH is going to just make up the scientific facts anyway? Is it of value for me to continue to conduct careful scientific evaluations of the impact of smoke-free policies, when groups are going to go around claiming that smoking bans will reduce heart attacks by an amount (40%) that is mathematically impossible?

What is the need for science at all if we are going to go around claiming that 30 minutes of secondhand smoke exposure can cause a fatal heart attack in a nonsmoker without pre-existing coronary artery disease? What is the need for science at all if we are going to go around claiming that a 30 minute exposure to secondhand smoke increases the risk of a fatal heart attack in a nonsmoker to that of a smoker?

If anti-smoking groups are going around making fallacious claims anyway, then is there a value to me devoting my research career to a search for the truth about the health effects of secondhand smoke?

Prior to the recent change in the tobacco control movement, there was a clear value to my research. But now that things have changed and the science is no longer important, it's not clear to me that there is a need for, or value to, continuing to conduct this research.

Why put out a valid body of scientific literature when groups are just going to basically make up the science for themselves?

Why devote my time to producing a solid scientific body of data when groups are just going to go around making mathematically impossible claims anyway?

Perhaps what discourages me the most is the fact that I see little concern among any anti-smoking groups about the lack of scientific accuracy in the movement. If I saw a great level of concern, if a number of anti-smoking groups were appalled at what is going on, then I would certainly feel a lot better. I might feel that it is worth my time to continue to conduct and disseminate the findings of careful scientific research.

But no group seems to care. If anything, they are just defending the poor science and attacking me for suggesting that anything is awry.

And this is not just limited to scientific analysis. It seems to apply to legal analysis as well.

As the Department of Justice lawsuit against the tobacco companies has demonstrated, anti-smoking groups seem to be disinterested in any kind of sound legal analysis. They see the DOJ case as an opportunity to present their wish lists for remedies (i.e, funding) and have paid little or no heed to the fact that remedies must actually be justified by the statute in question, as it has been clearly interpreted by the courts with jurisdiction over the case.

But the legal justification for remedies seems to be of little concern. Instead, when I suggested that perhaps the law did not support the monetary remedies that were requested, I was attacked, accused of being a traitor, and told to take a long vacation.

And the need for solid policy analysis seems to be dissipating as well. Now, smoking bans are being defended by arguing that we need to keep kids from seeing smokers in public. Banning smoking on sidewalks is being defended by arguing that pigeons might be harmed from ingesting cigarette butts. Firing smokers is being defended because it is legal. Not hiring smokers is being defended because it is unlikely that lots of employers will do so.

This is very frustrating for me because it's not clear to me that sound scientific analysis, sound legal analysis, and sound policy analysis have any major role in tobacco control anymore. And with that, it's not clear to me exactly what the need is for me to continue putting out the kind of research (including careful and detailed scientific, policy, and legal analyses) that I have been conducting for the past 20 years.

One of the keys to choosing an appropriate research question is asking the question: "Will the results of this study have a significant influence on public policy, one way or another?" If the answer is "no," then I don't see the research as being particularly valuable. I'm not casting doubt on the work others do here; I'm only pointing out my own criterion for choosing and pursuing a particular research question.

If ASH is going to go around claiming that short-term exposure to secondhand smoke causes fatal heart attacks in otherwise healthy nonsmokers and is using this "scientific data" to pursue an agenda of banning smoking virtually everywhere, then what possible role could my research on the health effects of secondhand smoke have at this time? Will the results of my work affect public policy if anti-smoking advocates are not using any judgment or discrimination in presenting "science" to policy makers?

In other words, why do we need valid data on the health effects of secondhand smoke if we can just make it up and claim anything that we want to?

Why continue to publish peer-reviewed scientific research if we can just take our unpublished work on tour and disseminate it before it has been considered and published by a scientific journal?

Why continue to pretend that scientific judgment and discussion is a valuable element of tobacco control if those who argue against the prevailing dogma of the movement are going to be expelled from list-serves, attacked, falsely accused of being tobacco stooges and naysayers, and slurred in some less favorable and derogatory ways?

I'm not posing these questions because I have an answer right now. I guess I'm looking for some help and some thoughts on the issue. Ultimately, I need to answer this question for myself, but it helps to be able to gain some insight from others.

There seem to be two approaches I can take. One is to try to change the anti-smoking movement so that an appreciation of the science returns. If scientific accuracy again becomes important in the movement, then I believe I have a major role to play in helping to produce that body of science which will appropriately inform policy and practice.

That's clearly my first choice. What I don't know, however, is whether this is a battle that can be won. Am I just banging my head against a proverbial wall (it doesn't feel just proverbial) or is speaking out against what I see as a lack of scientific integrity going to eventually have an impact?

The second choice is to give up on trying to produce new scientific studies, and to concentrate on just making sure that the results of existing studies are presented honestly and accurately. Obviously, this is not what I'd like to be doing, but if there is a legitimate need for it and someone has to fill that role, it might as well be me (I've already been attacked as being a tobacco stooge, so how much lower can it go?).

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About Me

Dr. Siegel is a Professor in the Department of Community Health Sciences, Boston University School of Public Health. He has 32 years of experience in the field of tobacco control. He previously spent two years working at the Office on Smoking and Health at CDC, where he conducted research on secondhand smoke and cigarette advertising. He has published nearly 70 papers related to tobacco. He testified in the landmark Engle lawsuit against the tobacco companies, which resulted in an unprecedented $145 billion verdict against the industry. He teaches social and behavioral sciences, mass communication and public health, and public health advocacy in the Masters of Public Health program.